Abnormal Ultrasonographic Findings among Referred Patients with Pain Abdomen in the Radiology Department of a Tertiary Care Center: A Descriptive Cross-sectional Study

ABSTRACT Introduction: Correct and prompt diagnosis is essential for the appropriate management of patients. Often, children and their caretakers cannot provide a reliable history to allow clinicians to determine the cause of the pain. This study's objective was to find out the prevalence of abnormal ultrasonographic findings among referred patients with pain abdomen in the radiology department of a tertiary care center of Nepal. Methods: A descriptive cross-sectional study was conducted among patients in the out-patient and emergency department with complaints of abdominal pain from 2021 April 5 to August 30 in a tertiary care hospital. Ethical clearance was taken from IRC (registration no: 423/2021). The convenience sampling method was used. Written informed consent was taken from each study participant. Collected data were entered and analyzed on Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Results: Among 250 patients with pain abdomen referred to the department of radiology, 169 (67.6%) (61.80-73.40 at 95% Confidence Interval) had abnormal ultrasonographic findings. Mean age of the patients was 39.4±17.9 years. Initial clinical diagnosis was in agreement with the abdominal ultrasound diagnosis in 57 (22.8%) patients. For the remaining 193 patients, the diagnosis obtained from abdominal ultrasound differed from the initial clinical diagnosis. Conclusions: Most of the cases of pain abdomen showed abnormalities in ultrasound. Clinical evaluation should be used together with ultrasound abdomen in order to arrive at a correct diagnosis.


INTRODUCTION
Abdominal pain is one of the most common symptoms among the patients to visit hospitals. 1 It can be caused by a variety of diseases ranging from mild and selflimiting to life-threatening diseases. 2 Approximately 10% of presentations at the Emergency Department are because of acute abdominal pain. 3 Among these, abdominal ultrasonography (USG) is a non-invasive procedure, which is readily available at most hospitals even during off-hours (weekends, nights and holidays) and may be performed at the bedside. 4 Abdominal pain is a frequent presentation in any general clinical setting in Nepal with 18% patients which normally had abdominal pain as a feature. 5 So, rapid diagnosis in time is always needed in the context of our country where computed tomography (CT) scan is not always available in every setting.

JNMA I VOL 59 I ISSUE 243 I November 2021
The aim of this study is to find out the prevalence of abnormal ultrasonographic findings among referred patients with pain abdomen in the radiology department of a tertiary care center of Nepal. The minimum required sample size was 196. But, we included 250 referred patients with pain in the abdomen from OPD and the emergency department to the radiology department of our center.

METHODS
All USG reports were kept in record separately. Day to day Performa was filled up and checked.
Data was entered in the Statistical Package for the Social Sciences version 20. The collected data was analyzed using the same. Descriptive statistics were used and variables were represented in terms of frequency and percentages. Point estimate at 95% CI was calculated.

DISCUSSION
In this study, the mean age of the patients was 39.4 ±17.9 years which was different from the previous study. [7][8][9] The cases referred for Ultrasound were mainly from OPD (71.2%) whereas 70% and 97.3% of the cases were from ER in a study done by Lameris W, et al. and by Nural MS,et al. 7,9 Out of 250 patients in our study 37.2% complained pain abdomen, 14% epigastric pain, 11.6%, lower abdominal pain and 10% loin pain whereas it was described differently in study done by Speets. 8 In our study, 32.1% cases were normal scans whereas 41% normal scans in Speets. 8 The initial clinical diagnosis made before Ultrasound diagnosis were appendicitis, cholecystitis, pancreatitis, umbilical hernia and others. A similar initial diagnosis was presented by Nural MS,et al. 9 This study revealed that 77.2% of initial diagnosis did not match with ultrasound diagnosis. This ratio is JNMA I VOL 59 I ISSUE 243 I November 2021 only 23% in study by Nural MS,et al. 9 So the cases should be diagnosed in accordance with the ACR appropriateness of imaging modality. It is considered that Ultrasonography is the initial imaging study of choice for evaluating patients with acute right upper quadrant pain with high ACR appropriate rating.
The present study had a relatively small number of patients examined. The number of patients was limited as the study was restricted to patients subjected to abdominal US as the first diagnostic imaging method.

CONCLUSIONS
Most of the cases of pain abdomen will show abnormalities in ultrasound. So, it should be used together with ultrasound abdomen in order to arrive at a correct diagnosis. Abdominal ultrasound was suitable for the diagnosis of patients with abdominal symptoms. It is recommended that Ultrasound diagnostic imaging be performed as first line diagnosing modality for patients and further referral to respective departments can treat patients in less time.